Endometriosis Explained
Understanding the Condition, Recognising the Signs, and Exploring Your Options
If you've recently been told you may have endometriosis, or you're wondering whether it could be contributing to infertility or pelvic symptoms, you're probably searching for clear answers.
Endometriosis is a common condition, yet it can be surprisingly difficult to diagnose. Some people experience severe pain that affects their daily lives, while others have very few symptoms and only discover they have endometriosis during fertility investigations or surgery.
This guide explains what endometriosis is, how it may affect fertility, how it is diagnosed, and the treatment options that may be available.
What is Endometriosis?
Endometriosis is a long-term condition in which tissue similar to the lining of the uterus (the endometrium) grows outside the uterus.
These growths are most commonly found on or around the:
ovaries
Fallopian tubes
outer surface of the uterus
pelvic lining (peritoneum)
bowel
bladder
More rarely, endometriosis can occur in other parts of the body.
Unlike the normal lining of the uterus, this tissue has no easy way to leave the body. Over time it can trigger inflammation, irritation, scar tissue (adhesions), and, in some cases, ovarian cysts called endometriomas.
How Common Is It?
Endometriosis affects millions of women worldwide and is one of the most common gynaecological conditions.
Despite this, many people wait years before receiving a diagnosis. Symptoms can vary widely, and they are sometimes mistaken for other conditions or dismissed as "normal period pain."
What Are the Symptoms?
Every person's experience is different.
Some people have severe symptoms.
Others have almost none.
Possible symptoms include:
painful periods
pelvic pain
pain during or after sex
pain when opening your bowels
pain when passing urine, particularly during your period
heavy menstrual bleeding
fatigue
bloating
bowel symptoms that may resemble irritable bowel syndrome (IBS)
difficulty becoming pregnant
Not everyone with endometriosis experiences pain, and the severity of symptoms does not always reflect the extent of the disease.
Can You Have Endometriosis Without Pain?
Yes.
This is sometimes referred to as silent endometriosis.
Some people have little or no pelvic pain and only discover the condition during investigations for infertility or another operation.
Because symptoms can be mild—or absent altogether—diagnosis may be delayed.
How Can Endometriosis Affect Fertility?
Not everyone with endometriosis has fertility problems, and many people with the condition conceive naturally.
However, endometriosis can make pregnancy more difficult for some people.
It may affect fertility in several ways, including:
inflammation within the pelvis
scar tissue (adhesions) that can affect the normal movement of the ovaries or Fallopian tubes
damage to the Fallopian tubes
ovarian cysts (endometriomas), which may affect ovarian tissue or treatment planning
changes to the pelvic environment that may make fertilisation more difficult
The exact reasons why endometriosis affects fertility are still being studied, and the impact varies from person to person.
How Is Endometriosis Diagnosed?
Diagnosis often begins with a discussion about your symptoms and a pelvic examination where appropriate.
Investigations may include:
Ultrasound scan
An ultrasound can identify some features, such as ovarian endometriomas, but a normal scan does not rule out endometriosis.
MRI scan
In some cases, MRI may help assess more extensive disease.
Laparoscopy
A laparoscopy is a surgical procedure in which a small camera is inserted through tiny cuts in the abdomen to look inside the pelvis.
For many people, laparoscopy has historically been considered the most reliable way to confirm endometriosis, and treatment may sometimes be carried out during the same procedure. In recent years, diagnosis and management have evolved, and your specialist will advise whether surgery is appropriate in your individual situation.
What Treatments Are Available?
Treatment depends on factors such as your symptoms, whether you're trying to conceive, the extent of the disease, and your personal preferences.
Options may include:
Pain relief
Over-the-counter or prescription pain medication may help manage symptoms.
Hormonal treatments
Hormonal medicines aim to reduce or suppress menstrual cycles and may improve symptoms for many people. They are generally not suitable if you are actively trying to become pregnant.
Surgery
Some people benefit from surgery to remove or destroy areas of endometriosis and reduce adhesions. Whether surgery is recommended depends on your individual circumstances.
Fertility treatment
If endometriosis is affecting fertility, your specialist may discuss options such as IVF or other assisted reproductive treatments where appropriate.
Living With Endometriosis
Living with endometriosis can be physically and emotionally challenging.
Many people describe feeling frustrated by delayed diagnosis or by having symptoms that are not immediately recognised.
If you're finding things difficult, remember that support is available through your healthcare team and reputable patient support organisations. You do not have to navigate this alone.
Questions You May Wish to Ask Your Doctor
You may find it helpful to ask:
Could endometriosis be contributing to my symptoms?
What investigations would you recommend?
Would an ultrasound be helpful?
Is MRI appropriate in my case?
What are the benefits and risks of laparoscopy?
Could endometriosis be affecting my fertility?
Which treatment options are most suitable for me?
Should I be referred to a specialist?
Key Points
✔ Endometriosis is a common condition where tissue similar to the lining of the uterus grows outside the uterus.
✔ Symptoms vary greatly, and some people have little or no pain.
✔ A normal ultrasound does not rule out endometriosis.
✔ Endometriosis can affect fertility, but many people with the condition conceive naturally.
✔ Treatment is individual and may include pain management, hormonal medication, surgery, or fertility treatment.
Related Guides
Silent Endometriosis Explained
Endometriosis and Fertility
Laparoscopy Explained
Hydrosalpinx Explained
Ultrasound Explained
Questions to Ask Your Doctor
Waiting for Results
A Personal Note
For many years, I was told there was no obvious reason why I wasn't becoming pregnant.
Eventually, I discovered I had bilateral hydrosalpinx caused by undiagnosed endometriosis. I had experienced very few symptoms, which is one reason the diagnosis came so late.
That experience inspired me to create this website. My hope is that by explaining investigations and conditions in clear, straightforward language, someone else might recognise a pattern, ask an important question, or reach the right diagnosis sooner than I did.